1Division of Cardiology, The Warren Alpert School of Medicine, Providence, RI, USA

2Cardiology Division, Hartford Hospital, Hartford, CT 06102, USA

pthomps{at}harthosp.org

Xanthelasmata are predictive, but arcus corneae is not

Most clinicians are aware that arcus corneae and xanthelasmata are related to hyperlipidaemia, but results have been conflicting on whether they provide extra information compared with traditional risk factors when predicting the risk of cardiovascular disease.123 In the linked prospective cohort study (doi:10.1136/bmj.d5497), Christoffersen and colleagues assess whether xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population.4

Arcus corneae and xanthelasmata are recognised signs of hyperlipidaemia when seen in younger patients.56 The arcus corneae associated with hyperlipidaemia, “arcus lipoides,” is a white discoloration of the peripheral cornea near the corneoscleral limbus, which is generally separated from the limbic edge by a zone of normal cornea.1 Arcus lipoides ranges from a barely visible arc in one of the poles of the cornea to a complete dense ring. In contrast, other age related peripheral corneal opacities commonly blur into the limbus.7 Arcus is more common in black people …